In 2010, the National Institute for Health and Care Excellence (NICE) published the guidance Transient loss of consciousness ('blackouts') management in adults. Orthostatic intolerance is characterised by the development of symptoms of dizziness, nausea and fainting when standing up, which are only resolved by lying down. The investigation of such symptoms is included in the NICE guidance, which can be found at the following link:

www.nice.org.uk/guidance/cg109/resources/guidance-transient-loss-of-consciousness-blackouts-management-in-adults-and-young-people-pdf

To support clinicians in the diagnosis, treatment, care and support of patients with chronic/complex regional pain syndrome (CRPS) the Royal College of Physicians (RCP) has produced a best practice guideline on the condition, which was produced with a range of collaborators, including the British Pain Society. In addition, in 2013 NICE produced a guideline on the pharmacological management of neuropathic pain, including for CRPS. Both the RCP and the NICE guidance can be found at the following links:

www.rcplondon.ac.uk/sites/default/files/documents/complex-regional-pain-full-guideline.pdf

www.nice.org.uk/guidance/cg173/resources/guidance-neuropathic-pain-pharmacological-management-pdf

No such assessment has been made. Mindfulness-based cognitive behavioural therapy is a specific National Institute for Health and Care Excellence-approved treatment available through Improving Access to Psychological Therapies services.

In response to the Chief Medical Officer’s (CMO’s) report 2008 report, the Healthcare Quality Improvement Partnership working with The British Pain Society and Dr Foster undertook the first ever National Pain Audit, which launched in 2009. The findings from the three year study, which appeared in three reports, highlighted variation in service provision and made a number of recommendations for the National Health Service to improve quality of care for patients suffering from chronic pain.

Since 1 April 2013, NHS England became responsible for the commissioning of specialised pain services for patients with chronic pain. NHS England has published a service specification for patients with chronic pain that sets out what providers must have in place in order to deliver evidence-based, safe and effective services. It supports equity of access to a nationally consistent, high quality service for patients. The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d08-spec-serv-pain-mgt.pdf

In the time since the CMO report, the National Institute for Health and Care Excellence (NICE) has produced a range of guidance to support clinicians to diagnose and treat a range of conditions causing ongoing pain, most recently publishing the 2013 guideline Neuropathic pain: The pharmacological management of neuropathic pain in adults in non-specialist settings. Finally, the British Pain Society collaborated with the Map of Medicine to produce a range of evidence-based pain care pathways, published in October 2014. These support NHS commissioners, providers and patients to access to high-quality, practice-informed care pathways that map the journey from initial presentation through to ongoing management of chronic pain. This can be accessed on the NHS Choices website at the following link:

http://www.nhs.uk/aboutNHSChoices/aboutnhschoices/partners/MapofMedicine/Pages/Introduction.aspx.

The Department has not commissioned specific research into complex regional pain syndrome (CRPS) but a range of related research is funded by the National Institute for Health Research (NIHR).

The NIHR Clinical Research Network is currently recruiting patients to two studies relating to CRPS:

- Development of an Electrical Sensory Discrimination Therapies device for the relief of chronic pain in CRPS. A proof of concept study

- An Intervention Trial to Investigate the Effectiveness of Visual Illusions in Manipulating Body Perception Disturbances to Reduce Chronic Pain and Improve Movement Performance

There is also an active Efficacy and Mechanism Evaluation (EME) Researcher-Led project (which is funded by the Medical Research Council and managed by NIHR):

- Low-dose Intravenous Immunoglobulin Treatment for Complex Regional Pain Syndrome (‘LIPS’) Randomised Controlled Trial.

Other research, carried out within the last two years, includes:

A Health Services and Delivery Research project:

- Meeting the support needs of patients with Complex Regional Pain Syndrome through innovative use of wiki technology

CRN studies:

- A Multi-Centre International Study Exploring the Patients' Definition of Recovery from Complex Regional Pain Syndrome

- Visually Manipulating Body Perception Disturbances to Treat Chronic Pain: An Exploratory Study

NIHR Career Development Fellowships:

- Understanding sensorimotor integration and its role in pain. Feasibility study to evaluate the potential of multi-modal imaging systems in CRPS

- Sensorimotor conflict and its relationship to behavioural and neurophysiological variables in CRPS, FMS, arthritis and healthy volunteers

The information requested is shown in the following table. These data are from hospital episode statistics and measure the time waited between decision to admit and admission to hospital. They are not the same as referral to treatment waiting times, which measure waiting times from referral to the start of consultant-led treatment by 18 treatment functions (subdivisions of consultant main specialties), but which do not include condition specific information.

The average (median) number of days waited for pain management treatment, 2012-13

Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre

Notes:

1. The data provided are finished admission episodes (FAEs) and outpatient first attendances where the treatment specialty was either pain management or paediatric pain management.
2. An FAE is the first period of admitted patient care under one consultant within one healthcare provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number of patients, as a person may have more than one admission within the period.
3. Attendances at outpatient clinics. Includes first and follow-up attendances and telephone consultations, excludes did not attends and cancellations.
4. Area Team of Residence is the area team containing the patient’s normal home address. This does not necessarily reflect where the patient was treated as they may have travelled to another area for treatment.
5. The treatment specialty is the specialty under which the consultant responsible for care of the patient is working, which may be different to the specialty under which the consultant is registered. Care is needed when analysing HES data by specialty, or by groups of specialties (such as "acute"). Trusts have different ways of managing specialties and attributing codes so it is better to analyse by specific diagnoses, operations or other recorded information.
6. The median, rather than the mean, time waited is given as the mean can be affected by a relatively small number of records with a long time waited, however the median is less affected by this issue.

We have had no such discussions. Botox is not licensed in the United Kingdom for use as a painkiller.

The National Institute for Health and Care Excellence (NICE) published technology appraisal guidance for the National Health Service in May 2012 which recommends botulinum toxin type A as a possible treatment for preventing headaches in some adults with chronic migraine, subject to certain clinical criteria.

Patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS, where their doctor believes they are clinically appropriate.